1.

Information for Medical Practitioners and Facilities

Transportation Management Initiative

Continues in New York

The New York State Department of Health (NYSDOH) and its contractor, LogistiCare Solutions, have

implemented non-emergency medical transportation management services for New York City

Medicaid fee-for-service enrollees (i.e., those not in a managed care plan) who are receiving

Medicaid covered services in Brooklyn and Queens.

All trips must be pre-arranged and confirmed by LogistiCare:

o Requests for routine services must be pre-arranged 72 hours (three days) in advance.

o Requests for urgent (same day or next day) care are arranged any time.

Key Transportation Telephone Numbers

Medical Facility Services

Department

877-564-5925

Monday – Friday

7a.m. – 6 p.m.

Providers may call to speak to one of our

specialists to request standing order or demand

response transport for an enrollee.

Medical Facility Services

Department fax

877-585-8758 (Brooklyn)

877-585-8759

(Queens)

24/7

Case managers or social workers fax the 2015

Medical Justification Form or the Standing Order

Request forms to this number.

Hospital Discharge

877-564-5926

24/7

Hospital discharges are handled quickly and

efficiently.

“Where’s My Ride”

877-564-5923

24/7

Call this number if there is a service issue or

complaint, or when the enrollee needs to be

picked up.

Reservation Number for

Enrollee Use

877-564-5922

Monday – Friday

7a.m. – 6 p.m.

This is the number a Medicaid fee-for-service

enrollee can call to request transportation.

Transportation Management Implementation Schedule for Rest of City

Bronx September 1, 2012

Manhattan September 1, 2012

Staten Island October 1, 2012

Managed Care Plan Enrollees

(other than long term care plans enrollees)

January 1, 2013

T H E O F F I C I A L N E W S L E T T E R O F T H E N E W Y O R K S T A T E M E D I C A I D P R O G R A M

New York State Visit us online: www.health.ny.gov J U L Y 2 0 1 2

VOLUME 28 NUMBER 8

2 | P a g e

July 2012 New York State Medicaid Update

Andrew M. Cuomo

GOVERNOR

State of New York

JULY 2012 NEW YORK STATE MEDICAID UPDATE

POLICY AND BILLING GUIDANCE

Transportation Management Initiative Continues in New York ................................................................................. cover

Written Orders Requirement for Preschool/School Supportive Health Services Program (SSHSP) ............................... 4

New York Medicaid Electronic Health Records Incentive Program Update .................................................................. 6

Mandatory Medicaid Managed Care Expanding To Wyoming County ........................................................................ 8

PHARMACY UPDATES

NYSMPEP Drug Information Response Center Addresses Pharmacotherapy in Patients with Prediabetes .............. 9

OMH Residential Treatment Facility Prescription Drug Carve-Out .................................................................................. 10

EPIC Update ............................................................................................................................................................................. 12

ALL PROVIDERS

New Training Schedule and Registration ............................................................................................................................. 15

Provider Directory .................................................................................................................................................................... 16

IN THIS

ISSUE …

3 | P a g e

July 2012 New York State Medicaid Update

(continued)

Transportation Management Initiative

Continues in New York

Can Enrollees Request Transportation to Medical Appointments?

New York City Medicaid enrollees may now request their own trips to and from their medical practice.

This may relieve providers of the administrative task of arranging trips.

Prior to May 2012, providers were required to arrange a Medicaid enrollee’s livery, ambulette and

stretcher transport. Now, all that is required is the Medicaid Transportation Justification Request (Form

2015) to document the need for transportation via livery, ambulette or ambulance. This document is

maintained by LogistiCare; when your patient requests a trip, we will confirm the necessary mode and

assign your preferred transportation provider to the appointment.

If the documentation is not on file, LogistiCare will contact you directly and ask you to submit the

Medicaid Transportation Justification Request.

This form, along with all other forms and policy material, is available online, at NYCMedicaidRide.net.

The form can be saved electronically, and maintained as part of your electronic record. Questions for

LogistiCare may be e-mailed to nyc@LogistiCare.com.

Questions regarding this article may be e-mailed to MedTrans@helath.state.ny.us, or via telephone at

(518) 473-2160.

POLICY AND BILLING GUIDANCE

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July 2012 New York State Medicaid Update

Written Orders Requirement for

Preschool/School Supportive Health

Services Program (SSHSP)

Pediatricians and other primary care providers serving children

with disabilities may be asked to write orders for medical services

provided through special education programs to students with

Individualized Education Programs (IEPs) under the

Preschool/School Supportive Health Services Program (SSHSP).

Preschool/School Supportive Health Services Program

(SSHSP)

Section 1903(c) of the Social Security Act permits payment of

certain Medicaid-covered services furnished to children with

disabilities if those services are included in an Individualized

Education Program (IEP). These services are provided as part of the special education programs in

school districts, counties, and §4201 schools (schools for the blind and deaf). In New York State,

Medicaid-covered services for students with an IEP under the SSHSP include:

1) Physical Therapy

2) Occupational Therapy

3) Speech Therapy

4) Psychological Evaluations

5) Psychological Counseling

6) Skilled Nursing

7) Medical Evaluations

8) Medical Specialist Evaluations

9) Audiological Evaluations

10) Special Transportation

Medicaid Managed Care and Fee-for-Service Medicaid

The services listed above, when received under the SSHSP, are carved-out of managed care and

billed directly to Medicaid fee-for-service by the school, county, or §4201 school. This means that even

if a child is enrolled in one of New York State’s managed care plans, SSHSP services themselves are

covered under fee-for-service Medicaid. However, whether the child is enrolled in a Medicaid

managed plan or has fee-for-service Medicaid, the primary care provider may still be requested by the

parent to supply a written order for service(s) that will be billed under SSHSP. In such instances, the

written order would be completed as part of the usual and customary care being furnished to the

child. The office or clinic visit is billable by the provider to the child’s managed care plan or to

Medicaid fee-for-service if the child is not enrolled in a plan. In some cases, the child’s IEP includes a

service that is not covered under the SSHSP, such as full time private duty nursing. Such services are the

responsibility of the child’s managed care plan.

-continued on next page-

POLICY AND BILLING GUIDANCE

5 | P a g e

July 2012 New York State Medicaid Update

(continued)

Written Orders Requirement for Preschool/School Supportive

Health Services Program (SSHSP)

Written Orders for SSHSP Services

Timely provision of written orders is important, as it establishes the medical necessity of the service

being furnished to the student and facilitates the school districts, counties, and §4201 schools in

accessing Medicaid funds to pay for IEP services.

The written order/referral must be in place prior to the provision of the service or the service is not

Medicaid reimbursable. School districts, counties, and §4201 schools will not be reimbursed for the

services they provide without this critical documentation.

Questions

For Medicaid policy questions, please contact the Office of Health Insurance Programs Policy

Department at (518) 473-2160.

For Medicaid managed care, please contact the enrollee’s health plan.

POLICY AND BILLING GUIDANCE

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July 2012 New York State Medicaid Update

New York Medicaid Electronic Health

Records Incentive Program Update The Department is pleased to announce that as of July 13, 2012, the New York Medicaid

Electronic Health Records (EHR) Incentive Program has now paid over $161 million in federal

incentive funds to over 1,940 New York State hospitals and healthcare practitioners.

NYSDOH continues to review applications for Payment Year 2011 incentive payments that were

submitted prior to the April 29, 2012 deadline, and applications for Payment Year 2012 are

currently being accepted from providers who are new to the incentive program. Applications for

providers’ second incentive payment (including Meaningful Use attestation) will be accepted

starting in the fourth quarter of calendar year 2012.

If you have not yet registered for the New York Medicaid EHR Incentive Program, we encourage

you to visit the eMedNY.org website at: https://www.emedny.org/meipass/ or attend one of the

informational webinars hosted by NYSDOH throughout the month of August.

Wednesday, August 1 3:00–4:00PM Eligible Professional Registration & Attestation

Thursday, August 2 12:00–1:00PM MEIPASS Prerequisites

Tuesday, August 7 10:00–11:00AM EP Support Documentation

Wednesday, August 8 3:00–4:00PM Meaningful Use, Stage 1 (Eligible Professionals)

Wednesday, August 15 12:00–1:00PM MEIPASS Prerequisites

Tuesday, August 21 10:00–11:00AM Eligible Professional Registration & Attestation

Thursday, August 23 12:00–1:00PM Meaningful Use, Stage 1 (Eligible Hospitals)

Tuesday, August 28 3:00–4:00PM Meaningful Use, Stage 1 (Eligible Professionals)

The webinar schedule is subject to change based on interest levels. To view the complete

schedule or to register for one of the webinars, please view the webinar schedules posted on the

eMedNY.org website at:

Current Month: https://www.emedny.org/meipass/webinar/Webinar.pdf

Next Month: https://www.emedny.org/meipass/webinar/NextMonth.pdf

POLICY AND BILLING GUIDANCE

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July 2012 New York State Medicaid Update

Mandatory Medicaid Managed Care

Expanding To Wyoming County

Beginning in July 2012, managed care enrollment will be

required for most Medicaid members residing in Wyoming

County. Once a mandatory managed care program is

implemented in a county, it is expected that the enrollment of

all eligible Medicaid members will take up to twelve months to

complete. Fidelis Care and Health Now health plans are

currently available in Wyoming County.

Providers should check the Medicaid Eligibility Verification System (MEVS) prior to rendering services to

determine Medicaid eligibility and the conditions of Medicaid coverage. Providers are strongly

encouraged to check eligibility at each visit as eligibility and enrollment status may change at any time. If

the Medicaid beneficiary is enrolled in a Medicaid managed care plan, the first coverage message will

indicate “Eligible PCP".

MEVS responses no longer include scope of benefits information therefore providers will need to contact

the health plan to determine what services the plan covers. Service Type codes will be used to identify

carved-out services where possible. Medicaid will not reimburse a provider on a fee-for-service basis if a

medical service is covered by the plan.

For more information on MEVS messages, please see the February 2011 Special Edition Medicaid Update

at: http://www.health.ny.gov/health_care/medicaid/program/update/2011/feb11mu_special.pdf.

Providers may call the eMedNY Call Center at (800) 343-9000 with any Medicaid billing issues. Medicaid

members may contact the New York Medicaid Choice at (800) 505-5678 or their local department of

social services (LDSS) to learn more about managed care.

For additional information on managed care covered services and managed care plan types, please

see the December 2010 Medicaid Update article entitled "Managed Care Covered Services" at:

http://health.ny.gov/health_care/medicaid/program/update/2010/2010-12.htm.

POLICY AND BILLING GUIDANCE

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July 2012 New York State Medicaid Update

NYSMPEP Drug Information Response

Center Addresses Pharmacotherapy in

Patients with Prediabetes

The New York State Medicaid Prescriber Education Program (NYSMPEP)

is a collaboration between the New York State Department of Health

(NYSDOH) and the State University of New York (SUNY), as approved by

state legislation. This program was designed to provide prescribers with

an evidence-based, non-commercial source of the latest objective

information about pharmaceuticals. In conjunction, the Drug

Information Response Center (DIRC) was developed to fulfill the mission

of assisting clinicians in the delivery of health care to their Medicaid

patients by providing timely, evidence-based information on

pharmacotherapy to prescribers and serving as a resource for

NYSMPEP academic educators in their outreach to prescribers. The

following review was prepared by the DIRC in response to a request for

information on the management of patients with prediabetes.

A number of organizations have published guidelines with recommendations for the management of

patients with prediabetes. The American Diabetes Association (ADA) defines prediabetes as a

condition associated with fasting plasma glucose (FPG) levels of 100 to 125 mg/dL or 2-hour plasma

glucose levels (after 75-g oral glucose tolerance test [OGTT]) of 140 to 199 mg/dL, or a glycosylated

hemoglobin (A1C) of 5.7 to 6.4%.1 For individuals who meet any of these criteria, the ADA recommends

referral to an ongoing support program promoting weight loss (≥7% ideally) and increased physical

activity (≥150 min per week) and consideration of metformin therapy in patients with a body mass

index (BMI) >35 kg/m2, age <60 years, and women with a history of gestational diabetes mellitus

(GDM). Annual monitoring for diabetes development is recommended for all patients with

prediabetes. Regarding drug therapy, the ADA specifies metformin as the only drug that should be

considered. Other medications such as thiazolidinediones, alpha-glucosidase inhibitors, and incretin

mimetics have been studied, but due to cost issues, side effects, and lack of data demonstrating

consistent effects, these drugs are not recommended.1,2

The American Association of Clinical Endocrinologists (AACE) defines prediabetes similarly, with the

exception of A1C levels (5.5 to 6.4% as opposed to 5.7 to 6.4%) and an inclusion of metabolic

syndrome as defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel

(ATP) III criteria as a prediabetes equivalent.3 Like the ADA, the AACE recommends annual monitoring

for diabetes in these patients, in addition to addressing excessive weight and cardiovascular disease

(CVD) risk factors. Weight loss of ≥7% is recommended, as is reduction in caloric intake (≥500 kcal/day)

and regular exercise (≥30 min/day). Regarding drug therapy, the AACE suggests that metformin or

perhaps thiazolidinediones be considered for younger patients at moderate to high risk of developing

diabetes, those with additional CVD risk factors (e.g., hypertension, dyslipidemia, or polycystic ovarian

syndrome), a family history of diabetes in a first-degree relative, and/or patients who are obese.

-continued on next page-

PHARMACY UPDATE

9 | P a g e

July 2012 New York State Medicaid Update

From a search of the literature, several studies have been conducted evaluating drug therapy for

prevention of diabetes. In addition to those outlined in the ADA guidelines,4-7 several meta-analyses

have been published. Lily and Godwin sought to determine the efficacy of metformin in the

prevention of diabetes8 in which they identified three randomized controlled trials for analysis.

Doses of metformin used in the studies varied from 250 mg twice daily, to 250 mg three times daily, and

850 mg twice daily. Lifestyle modifications in conjunction with metformin or placebo were evaluated in

1 study. Follow-up periods ranged from 12 months to 3 years. Overall, metformin therapy was found to

result in a decreased risk of diabetes development (odds ratio [OR] 0.65, 95% confidence interval [CI]

0.55 to 0.78). Of note, in observing the results of the individual studies, not all demonstrated a

significant reduction in the rate of diabetes development.

Hopper et al conducted a meta-analysis evaluating the effect of both pharmacologic and non-

pharmacologic interventions in patients with prediabetes on incidence of all-cause and

cardiovascular-related mortality.9 The investigators included trials involving a minimum of 100 patients

with a follow-up time of ≥1 year. A total of 10 trials were included, with 23,152 patients, and a mean

follow-up period of 3.75 years. Interestingly, the investigators determined that patients with non-

pharmacologic interventions (e.g., dietary modifications and exercise) were superior to drug therapy in

the prevention of diabetes with risk ratios of 0.52 (95% CI: 0.46 to 0.58) vs. 0.70 (95% CI: 0.58 to 0.85;

p<0.05). No differences were observed between these groups in the incidence of all-cause mortality

and cardiovascular death.

As described in the ADA and AACE guidelines, drug therapy is not strongly recommended for

prevention of diabetes in all patients with prediabetes. Both organizations qualify those who may be

better candidates, based on the results of the outlined studies. It appears that metformin may be most

appropriate when considering initiation of drug therapy for prevention of diabetes. Of note, there is no

one dosing recommendation for metformin that has been determined to be superior. All patients with

prediabetes, however, should receive counseling on lifestyle modifications targeting weight loss and

increased physical activity and be monitored at least annually for development of diabetes.

To contact a NYSMPEP academic educator in your area, please visit:

http://nypep.nysdoh.suny.edu/contactus.

References:

1. American Diabetes Association. Standards of medical

care in diabetes—2012. Diabetes Care. 2012;35(Suppl

1):S11-S63.

2. Moutzouri E, Tsimihodimos V, Rizos E, Elisaf M. Prediabetes:

to treat or not to treat? Eur J Pharmacol. 2011;672(1-3):9-

19.

3. Handelsman Y, Mechanick JI, Blonde L, et al. American

Association of Clinical Endocrinologists medical guidelines

for clinical practice for developing a diabetes mellitus

comprehensive care plan. Endocr Pract. 2011;17(Suppl

2):1-53.

4. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction

in the incidence of type 2 diabetes with lifestyle

intervention or metformin. N Engl J Med. 2002;346(6):393-

403.

5. Chiasson JL, Josse RG, Gomis R, et al. Acarbose for

prevention of type 2 diabetes mellitus: the STOP-NIDDM

randomized trial. Lancet. 2002;359(9323):2072-2077.

6. DREAM (Diabetes REduction Assessment with ramipril and

rosiglitazone Medication) Trial Investigators, Gerstein HC,

Yusuf S, et al. Effect of rosiglitazone on the frequency of

diabetes in patients with impaired glucose tolerance or

impaired fasting glucose: a randomized controlled trial.

Lancet. 2006;368(9541):1096-1105.

7. Ramachandran A, Snehalatha C, Mary S, et al. The Indian

Diabetes Prevention Programme shows that lifestyle

modification and metformin prevent type 2 diabetes in

Asian Indian subjects with impaired glucose tolerance

(IDPP-1). Diabetologia. 2006;49(2):289-297.

8. Lily M, Godwin M. Treating prediabetes with metformin:

systematic review and meta-analysis. Can Fam Physician.

2009;55(4):363-369.

9. Hopper I, Billah B, Skiba M, Krum H. Prevention of diabetes

and reduction in major cardiovascular events in studies of

subjects with prediabetes: meta-analysis of randomized

controlled clinical trials. Eur J Cardiovasc Prev Rehabil.

2011;18(6):813-823.

PHARMACY UPDATE

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July 2012 New York State Medicaid Update

OMH Residential Treatment Facility

Prescription Drug Carve-Out Effective September 1, 2012, reimbursement of prescription drugs for residents

of the Office of Mental Health (OMH) Residential Treatment Facilities (RTF) will

be covered as a Medicaid fee-for-service (FFS) benefit and billed directly to

Medicaid by the dispensing pharmacy. There are currently 19 facilities

statewide, with a total of 554 certified beds.

The change only affects prescription drugs. Physician administered drugs,

commonly referred to as J-code drugs, and over-the-counter (OTC) drugs,

medical supplies, immunization services (vaccines and their administration),

nutritional supplies, sick room supplies, adult diapers, and durable medical

equipment (DME) will not be carved out of the RTF rate and will remain the

responsibility of the facility.

The NYS Medicaid FFS program only provides reimbursement for prescription

drugs included on the NYS Medicaid Pharmacy List of Reimbursable Drugs,

which can be found at: http://www.emedny.org/info/formfile.html.

Once this change takes effect, RTF providers will no longer purchase

prescription drugs for the children and youth in their programs. Prescriptions

must be written on the Official New York State Prescription Form (ONYSRx), with only one medication

permitted per form. Prescriptions must then be dispensed and billed by a Medicaid enrolled pharmacy,

using the child’s individual Medicaid Client Identification Number (CIN). These children do not have

Medicaid benefit cards; therefore, the OMH RTF will provide the CIN to the pharmacy.

Pharmacy Enrollment Information

Pharmacies that supply prescription drugs to OMH RTFs must be enrolled in the Medicaid program in

order to submit claims for reimbursement. No other entity can function as a billing agent for a LTC

pharmacy.

Enrollment information can be found at the following Web sites:

Pharmacy Enrollment Packet:

o http://www.emedny.org/info/ProviderEnrollment/FFS%20Enrollment%20Packets/4090-

Pharmacy%20Enrollment%20Packet/4090-Pharmacy.pdf.

Additional information to be submitted by out-of-state pharmacies:

o http://www.emedny.org/info/ProviderEnrollment/FFS%20Enrollment%20Packets/4020-

Out%20of%20State%20Pharmacy/4020-

Out%20of%20State%20Pharmacy%20Applicants.pdf.

PHARMACY UPDATE

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July 2012 New York State Medicaid Update

Prior Authorization Programs

The Medicaid program requires prior authorization for certain drugs through the Preferred Drug

Program (PDP), Mandatory Generic Drug Program (MGDP), Clinical Drug Review Program (CDRP), and

Brand When Less Than Generic Program (BLTG). The prescriber may need to obtain prior authorization

for certain drugs. General information on prescription drug prior authorization can be found on the

Magellan Medicaid Administration Web site available at: https://newyork.fhsc.com.

Note: If a prior authorization number has not been obtained by the prescriber and the pharmacist is

unable to reach the prescriber, the pharmacist may obtain a prior authorization for up to a 72 hour

emergency supply of a multi-source brand-name or non-preferred drug, subject to State laws and

Medicaid restrictions. Once a 72 hour supply prior authorization number is given and a 72 hour supply is

dispensed, the prescription is no longer valid for the remaining quantity and refills. The pharmacist is

expected to follow-up with the prescriber to determine future needs.

Pharmacy Program information can be found on the Medicaid Pharmacy Program web page located

at: http://www.health.ny.gov/health_care/medicaid/program/pharmacy.htm.

Information on the specific prior authorization programs as well as FQD/Step Therapy requirements can

be found at the following websites:

o Preferred Drug Program

https://newyork.fhsc.com/providers/PDP_about.asp

o Mandatory Generic Drug Program

https://newyork.fhsc.com/providers/MGDP_about.asp

o Clinical Drug Review Program

https://newyork.fhsc.com/providers/CDRP_about.asp

o Brand When Less Than Generic Program

http://nyhealth.gov/health_care/medicaid/program/docs/bltg.pdf

o Step Therapy (ST) Program

http://www.health.ny.gov/health_care/medicaid/program/dur/docs/step_therapy.pdf

o Frequency/Quantity/Duration (F/Q/D) Program

http://www.health.ny.gov/health_care/medicaid/program/dur/docs/fqd_program.pdf

Questions?

Additional information regarding the Medicaid prior authorization programs is available online at:

https://newyork.fhsc.com/ or by calling (877) 309-9493. For pharmacy billing questions, please call (800)

343-9000.

PHARMACY UPDATE

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July 2012 New York State Medicaid Update

PROVIDER BULLETIN

P.O. BOX 15018, ALBANY, NY 12212-5018 (800) 634-1340

BULLETIN NO. 08-01 August 2012

SUBJECT: EPIC Program Changes

Beginning January 1, 2013, many EPIC program benefits will be restored. This bulletin provides

information about these changes as well as how they will affect both your EPIC customers and your

pharmacy.

ALL MEMBERS MUST BE ENROLLED IN A MEDICARE PART D PLAN IN ORDER

TO RECEIVE EPIC BENEFITS

Claims:

o EPIC will provide secondary coverage for EPIC and Medicare Part D covered drugs after any

Part D and/or EPIC deductible is met. EPIC will also cover many Medicare Part D excluded

drugs, e.g. prescription vitamins, prescription cough and cold preparations.

o Low Income Subsidy (LIS) members will be able to use EPIC during all Medicare Part D benefit

stages.

o Any amount paid toward the Medicare Part D deductible cannot be applied to the EPIC

deductible.

o The EPIC manufacturers’ rebate program is being reinstated.

EPIC Participant Eligibility:

o The Fee Plan will be restored. Members with full Low Income Subsidy (LIS) will have their EPIC

fees waived. EPIC co-payments will continue to range from $3 - $20 based on the cost of the

drug.

o The Deductible Plan will be restored. EPIC members with higher incomes will be responsible for

paying their own Medicare Part D premium. However, their EPIC deductible will be lowered by

the annual cost of a basic Medicare Part D drug plan.

o EPIC will continue to pay Medicare Part D premiums, up to the amount of a basic plan, for

members in the Fee and Deductible plans with income up to $23,000 (single) or $29,000

(married).

Attached you will find a copy of the Good News letter mailed to EPIC members. If you have any

questions, please contact the EPIC Provider Helpline at (800) 634-1340.

13 | P a g e

July 2012 New York State Medicaid Update

IMPORTANT NOTICE

Attention Prescribers August 2012

Effective January 1, 2013, many Elderly Pharmaceutical Insurance Coverage (EPIC) program benefits

will be restored. This notice provides information about these changes and how they may affect your

patients.

o EPIC eligibility remains the same. You must

be a resident of New York State 65 or older

have annual income up to $35,000 if single or $50,000 if married, and

may have a Medicaid Spend down but not receiving full Medicaid benefits.

o EPIC members must be enrolled in a Medicare Part D plan in order to receive EPIC benefits.

o EPIC will reinstate its Fee and Deductible Plans.

o EPIC will provide secondary coverage for EPIC and Medicare Part D covered drugs after any

Part D and/or EPIC deductible is met.

o EPIC co-payments for covered drugs will continue to be $3 - $20, depending on the cost of the

drug.

o EPIC will continue to cover many Medicare Part D excluded drugs, such as prescription vitamins

and prescription cough and cold preparations.

o EPIC will continue to pay Medicare Part D premiums, up to the amount of a basic plan, for

members in the Fee and Deductible plans with income up to $23,000 (single) or $29,000

(married).

o EPIC will also lower the EPIC deductible, by the annual cost of a basic Medicare Part D drug

plan, for members with higher incomes that are responsible for paying their own Medicare Part

D premium.

If your patients are currently receiving drugs that are not on their Part D formularies, please discuss

alternative drug therapies that will be covered by their Part D plans in 2013. Prescribing drugs on the

Medicare Part D formulary will maximize coverage and reduce your patients’ out of pocket expenses.

EPIC has included a copy of the letter sent to members explaining these program changes. If you have

patients who have questions about how these changes will affect them, please have them contact

the EPIC Participant Helpline at (800) 332-3742.

If you have any questions or require further assistance please contact the EPIC Provider Helpline at

(800) 634-1340.

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July 2012 New York State Medicaid Update

NEW YORK STATE SENIOR PRESCRIPTION PLAN

P.O. BOX 15018, ALBANY, NY 12212-5018 (800) 332-3742

August 2012

GOOD NEWS FOR EPIC MEMBERS!

On January 1, 2013, the Elderly Pharmaceutical Insurance Coverage (EPIC) program will change back

to a fee and deductible program and provide you with expanded prescription coverage! All

members must be enrolled in a Medicare Part D drug plan to receive EPIC benefits. There will be no

exceptions.

EPIC will provide secondary prescription coverage for EPIC and Medicare Part D covered drugs after

the Part D deductible, if you have one, is met. EPIC will also cover many Medicare Part D excluded

drugs (e.g. prescription vitamins and prescription cough and cold preparations).

You will be enrolled in either the EPIC Fee Plan or Deductible Plan, based on your income.

o Fee Plan members will pay an annual fee to EPIC. An EPIC bill will be mailed out in December.

Members will pay EPIC co-payments ranging from $3 - $20 for prescriptions after the Medicare

Part D deductible, if you have one, is met. Those with full Extra Help from Medicare will have

their EPIC fees waived.

o Deductible Plan members must meet an out-of-pocket deductible before paying EPIC co-

payments ranging from $3 - $20 for prescriptions. The amount paid toward the Medicare Part D

deductible, if you have one, cannot be applied to the EPIC deductible.

EPIC will continue to pay Medicare Part D plan premiums, up to the amount of a basic plan, for all

members with annual income below $23,000 if single or $29,000 if married. EPIC members with higher

incomes will be responsible for paying their own Medicare Part D premium. However, their EPIC

deductible will be lowered by the annual cost of a basic Medicare Part D drug plan.

If you have any questions about these changes please contact the EPIC Provider Helpline at

(800) 634-1340 Monday through Friday from 8:30 AM to 5:00 PM. Call the toll-free EPIC Helpline at

(800) 332-3742.

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July 2012 New York State Medicaid Update

New Training Schedule and Registration

o Do you have billing questions?

o Are you new to Medicaid billing?

o Would you like to learn more about ePACES?

If you answered YES to any of these questions, you should consider registering for a Medicaid training

session. Computer Sciences Corporation (CSC) offers various types of educational opportunities to

providers and their staff. Training sessions are available at no cost to providers and include information

for claim submission, Medicaid Eligibility Verification, and the eMedNY Website.

Web Training Now Available

You can also register for a webinar in which training would be conducted

online and you can join the meeting from your computer and telephone.

After registration is completed, just log in at the announced time. No

travel involved.

Many of the sessions planned for the upcoming months offer detailed

instruction about Medicaid’s free web-based program-ePACES which is

the electronic Provider Assisted Claim Entry System that allows enrolled

providers to submit the following type of transactions:

o Claims

o Eligibility Verifications

o Claim Status Requests

o Prior Approval/DVS Requests

Physician, Nurse Practitioner, DME and Private Duty Nursing claims can even be submitted in "REAL-

TIME" via ePACES. Real-time means that the claim is processed within seconds and professional

providers can get the status of a real-time claim, including the paid amount without waiting for the

remittance advice.

Fast and easy registration, locations, and dates are available on the eMedNY Website at:

http://www.emedny.org/training/index.aspx

CSC Regional Representatives look forward to having you join them at upcoming meetings!

If you are unable to access the Internet to register or have questions about registration, please contact

the eMedNY Call Center at (800) 343-9000.

ALL PROVIDERS

16 | P a g e

July 2012 New York State Medicaid Update

Office of the Medicaid Inspector General:

For general inquiries or provider self-disclosures, please call (518) 473-3782.

For suspected fraud complaints/allegations, call 1-877-87FRAUD (1-877-873-7283), or visit

www.omig.ny.gov.

Provider Manuals/Companion Guides, Enrollment Information/Forms/Training Schedules:

Please visit the eMedNY web site at: www.emedny.org.

Providers wishing to hear the current week’s check/EFT amounts:

Please call (866) 307-5549 (available Thursday PM for one week for the current week's amount)

Do you have questions about billing and performing MEVS transactions?

Please call the eMedNY Call Center at (800) 343-9000.

Provider Training:

To sign up for a provider seminar in your area, please enroll online at:

http://www.emedny.org/training/index.aspx. For individual training requests,

call (800) 343-9000 or e-mail: emednyproviderrelations@csc.com.

Enrollee Eligibility:

Call the Touchtone Telephone Verification System at (800) 997-1111.

Address Change?

Address changes should be directed to the eMedNY Call Center at (800) 343-9000.

Fee-for-Service Providers: A change of address form is available at:

http://www.emedny.org/info/ProviderEnrollment/allforms.html.

Rate-Based/Institutional Providers: A change of address form is available at:

http://www.emedny.org/info/ProviderEnrollment/allforms.html.

Does your enrollment file need to be updated because you've experienced a change

in ownership?

Rate Base/Institutional and Fee-for-Service providers, please call (518) 474-3575, Option 4.

Do you have comments and/or suggestions regarding this publication?

Please contact Kelli Kudlack at: medicaidupdate@health.state.ny.us.

PROVIDER DIRECTORY